For a potentially malignant lymphadenopathy, it is clinically important to distinguish between metastasis of a primary tumor and a benign lesion such as systemic sarcoidosis or sarcoid reaction. We describe here a case of systemic sarcoidosis that was associated with early gastric cancer. A patient was found to have early gastric cancer (EGC) during routine clinical examination. The chest radiography demonstrated bilateral hilar lymphadenopathy and further examination showed that he had multiple lymphadenopathies. We diagnosed systemic sarcoidosis with EGC because of the elevated serum ACE-I, the chest CT findings and the pathological analysis. We performed endoscopic submucosal dissection (ESD) for EGC, and there was no local recurrence and distant metastasis for eighteen months. These findings suggest that the possibility of systemic sarcoidosis should be considered in cases with established malignancy and multiple lymphadenopathies.
Humans ; Lymphatic Diseases ; Neoplasm Metastasis ; Recurrence ; Sarcoidosis ; Stomach Neoplasms ; Thorax

Pregnancy causes alterations in bile compositions and, an increased incidence of cholelithiasis and the complications related to it. This often requires endoscopic interventions such as endoscopic retrograde cholangiopancreatography (ERCP), but the radiation exposure during the ERCP may be harmful to the fetus. We report here on a case of successful ERCP and therapeutic endoscopic intervention without fluoroscopic guidance for a pregnant woman with common bile duct stone that was complicating her biliary pancreatitis.
Bile ; Cholangiopancreatography, Endoscopic Retrograde ; Cholelithiasis ; Common Bile Duct ; Female ; Fetus ; Humans ; Incidence ; Pancreatitis ; Pregnancy ; Pregnant Women

Human parvovirus B19 infection could be manifested as pure red cell aplasia or chronic anemia in immunocompromised host. The patient was 35-year-old female who had been diagnosed as non-Hodgkin lymphoma, peripheral T-cell unspecified type and had been performed chemotherapy. She complained headache and dizziness that was found to a marked drop in hemoglobin (3.2g/dL). A bone marrow aspiration revealed findings consistent with erythroid hypoplasia with maturation arrest. Serum parvovirus B19 PCR and anti parvovirus B19 IgM were positive. After immunoglobulin therapy, it was leading to a marked increase in reticulocyte count and corresponding rise in hemoglobin. To our knowledge, this is the first report to use immunoglobulin in an adult cancer patient with pure red-cell aplasia. Human parvovirus B19 infection should be considered in immunocompromised cancer patients with red cell aplasia and early use of immunoglobulins would be helpful in resolution of anemia and not to delay planned chemotherapy.
Adult ; Anemia ; Bone Marrow ; Dizziness ; Drug Therapy ; Female ; Headache ; Humans ; Immunization, Passive* ; Immunocompromised Host ; Immunoglobulin M ; Immunoglobulins* ; Lymphoma, Non-Hodgkin ; Parvovirus B19, Human ; Parvovirus* ; Polymerase Chain Reaction ; Red-Cell Aplasia, Pure* ; Reticulocyte Count ; T-Lymphocytes

A-61-year-old COPD patient was hospitalized due to dyspnea and was diagnosed with acute exacerbation of COPD. During the hospital stay, the patient's dyspnea was aggravated by massive spontaneous subcutaneous emphysema. Multiple 16 gauge intravenous catheters were inserted at the midclavicular line for drainage. Although subcutaneous catheter drainage was carried out, respiratory failure developed with an increased in massive subcutaneous emphysema. Continuous suction drainage with wall suction was applied resulting in the rapid resolution of the subcutaneous emphysema. We report a case of the that effective management of massive subcutaneous emphysema using multiple 16 gauge intravenous catheters with continuous suction.
Catheters* ; Drainage ; Dyspnea ; Humans ; Length of Stay ; Pulmonary Disease, Chronic Obstructive ; Respiratory Insufficiency ; Subcutaneous Emphysema* ; Suction*

No abstract available.
Adult* ; Humans ; Osteomalacia*

No abstract available.
Diabetic Retinopathy ; Follow-Up Studies ; Humans ; Photography

Acute pancreatitis may complicate viral hepatitis B, as well as the other causes of viral hepatitis. There have been reports of acute pancreatitis complicating acute exacerbations of chronic hepatitis B virus infection, most of which were related to immunosuppressive treatment or organ transplantation. However, acute pancreatitis complicating spontaneous acute exacerbation of chronic hepatitis B virus infection is rare. We report a case of acute pancreatitis that developed while a spontaneous acute exacerbation of chronic hepatitis B virus infection was underway in a healthy carrier.
Hepatitis ; Hepatitis B ; Hepatitis B, Chronic ; Hepatitis, Chronic ; Organ Transplantation ; Pancreatitis ; Transplants ; Viruses

BACKGROUND/AIMS: Nonalcoholic steatohepatitis (NASH) is commonly diagnosed using the semi-quantitative grading and staging system proposed by Brunt et al. in 1999. The Pathology Committee of the NASH established the nonalcoholic fatty liver diseases (NAFLD) activity score (NAS) in 2005. The aim of this study was to elucidate the validity and reliability of the NAS in Korean NAFLD patients. METHODS: Fifty-six patients on whom sonography-guided liver biopsy for well-defined NAFLD was performed between 1999 and 2007 were identified retrospectively. Two pathologists evaluated each biopsy sample. NAFLD was evaluated using both the grading system developed by Brunt et al. and the NAS. Each pathologist was blinded to the patients' clinical data and scored independently. We evaluated the body mass index (BMI), liver enzymes, lipid profile, peripheral insulin resistance, leptin, insulin/c-peptide ratio, ferritin, and fasting blood glucose. RESULTS: The patients were aged 32.1+/-12.5 years (mean+/-SD) and comprised 44 males (78.6%). Patients with different grades at the two grading systems had mild steatosis or ballooning changes with fibrosis, and 36.6% of them were borderline cases (NAS of 3 or 4). The interobserver agreement on diagnostic category was 0.748 (P<0.001) for the NAS (using weighted kappa statistics). Elevated fasting glucose, ALT, and triglyceride were associated with the NAS. CONCLUSIONS: The simple and reproducible NAS was found to be a useful pathologic grading system in Korean NAFLD patients. However, the proportion of borderline cases based on the NAS was high. The "wait and see" strategy is necessary for evaluating the long-term prognosis.
Adult ; Alanine Transaminase/blood ; Asian Continental Ancestry Group ; Blood Glucose/analysis ; Fatty Liver/*pathology/ultrasonography ; Female ; Ferritins/blood ; Fibrosis ; Humans ; Insulin Resistance ; Male ; Middle Aged ; Reproducibility of Results ; Republic of Korea ; Retrospective Studies ; *Severity of Illness Index ; Triglycerides/blood ; Validation Studies as Topic

PURPOSE: To analyze the survival outcomes and prognostic factors in glioblastoma patients treated with surgery and radiation therapy. MATERIALS AND MEHTODS: One hundred twenty glioblastoma patients treated with postoperative radiation therapy from 1994 to 2003 at Samsung Medical Center were retrospectively reviewed. Surgical extents were gross total resection in 22 patients (18%), subtotal resection in 69 (58%), and biopsy only in 29 (24%). The median radiation dose was 60 Gy, ranging from 45 Gy to 72 Gy. The median follow-up period was 12 months ranging from 2 to 62 months. RESULTS: The overall 1- and 2-year survival rates were 52% and 14%, respectively, and the median survival duration was 13 months. Favorable prognostic factors by Uunivariate analyses of prognostic factors on 1-year survival rate wererevealed that age under 50 (p<0.01), ECOG performance status 0 or 1 (p=0.03), single lesion (p=0.02), and gross total resection (p=0.04), were the favorable prognostic factors. and by Mmultivariate analyses wererevealed that female (p<0.01), age under 50 (p<0.01), ECOG performance status 0 or 1 (p=0.05) and gross total resection (p=0.05) were the favorable prognostic factors. CONCLUSIONS: The results of our study were comparable with those previously reported. To improve treatment outcome, various modifications, including radiation dose escalation through newer radiation therapy techniques and use of effective chemotherapy regimen, should be further investigated. investigated. Also Furthermore, the application of individualized treatment strategy based on the patient's' prognostic factors might be needed.
Biopsy ; Drug Therapy ; Female ; Follow-Up Studies ; Glioblastoma* ; Humans ; Retrospective Studies ; Survival Rate ; Treatment Outcome

Patients with NIDDM are at increased risk for the development of coronary atherosclerosis and experience more silent myocardial infarction than non-diabetic subjects. The screening tools for early detection of coronary artery disease without significant narrowing has been requested in diabetic patients. Coronary artery calcification (CAC) score, quantified by electron beam computed tomography (EBT), have been reported to correlate with the amount of atherosclerotic plaque and vascular luminal narrowing. We investigated the distribution of CAC score and associated risk factors in asymptomatic NIDDM patients and patients with ischemic heart disease to estimate the usefulness of CAC as a screenig tool for ischemic heart disease in asymptomatic diabetes. METHOD: 136 NIDDM patients without any symptom of coronary artery disease and 37 patients with significant coronary artery stenosis were included. CAC were measured by electron bean tomography (ultrafast CT). Forty contiguous 3-mm thickness transverse two-dimensional sections were obtained through root of aorta and heart. Coronary calcification were defined as the presense of at least two adjacent pixel within the border of visualized coronary artery with CT number of at least 130 HU. Body mass index, waist-hip ratio were measured and body fat components were counted by impedence method. Visceral fat versus subcutaneous fat ratio were calculated by abdominal computed tomography. Plasma lipid profile, fasting insulin, C-peptide level, HbA1c concentration were measured. Correlations between natural log of CAC score and clinical parameters were evaluated and multiple regression analysis with natural log of CAC score as a independent variable was performed. Coronary angiography were performed in 17 asymptomatic NIDDM patients.. RESULT: CAC score was significantly higher in male than female subjects and increased significantly with aging (p<0.01). In patients with hypertension, previous history of cerebrovascular or peripheral vascular disease (p<0.05), CAC score was significantly increased. The CAC score showed significant positive correlations with smoking amount, duration of diabetes and a negative correlation with HDL-cholesterol (p<0.05). There were no association between CAC score and total cholesterol, LDL-cholesterol, waist to hip circumference ratio, or fasting insulin levels. After adjustment of compounding variables (age, sex), duration of diabetes, amount of smoking and previous history of atherosclerotic vascular disease were shown to be associated with CAC score. In multiple logistic regression analysis with natural log of CAC score as dependent variable, age, HDL-cholesterol, duration of diabetes, male gender were found to be significant independent variables. Seventeen diabetic patients with high CAC score, were taken coronary angiography and significant luminal narrowings (more than 50%) of coronary artery were documented in 16 patients. But, In 7 out of 17 patients with coronary one-vessel disease, coronary calcification were not detected by EBT. CONCLUSION: coronary artery calcium score quantified by electron beam computed tomography may be useful for screening of preclinical or asymptomatic coronary artery disease in asymptomatic NIDDM patients.
Adipose Tissue ; Aging ; Aorta ; Body Mass Index ; C-Peptide ; Calcium ; Cholesterol ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Disease ; Coronary Stenosis ; Coronary Vessels* ; Diabetes Mellitus ; Diabetes Mellitus, Type 2 ; Fasting ; Female ; Heart ; Hip ; Humans ; Hypertension ; Insulin ; Intra-Abdominal Fat ; Logistic Models ; Male ; Mass Screening* ; Myocardial Infarction ; Myocardial Ischemia ; Peripheral Vascular Diseases ; Phenobarbital ; Plaque, Atherosclerotic ; Plasma ; Risk Factors ; Smoke ; Smoking ; Subcutaneous Fat ; Tomography, X-Ray Computed* ; Vascular Diseases ; Waist-Hip Ratio